Induction chemotherapy followed by surgery in node positive bladder cancer

Richard P Meijer, Laura S Mertens, Bas W van Rhijn, Axel Bex, Henk G van der Poel, Wim Meinhardt, J Martijn Kerst, Andre M Bergman, Annemarie Fioole-Bruining, Erik van Werkhoven, Simon Horenblas

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To evaluate the outcome and prognostic factors of patients with node positive bladder cancer (NPBC), who were eligible for surgery and treated with induction chemotherapy.

METHODS: All consecutive patients with NPBC, who were treated with at least 2 cycles of induction chemotherapy and initially scheduled for surgery, between 1990 and 2012, were identified from an institutional bladder cancer database. Induction chemotherapy consisted of MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) or gemcitabine with cisplatin (Gem/Cis) or carboplatin (Gem/Carbo).

RESULTS: One hundred forty-nine patients with NPBC (mean age, 60 years; range, 31-79) were treated with induction chemotherapy. Median cancer-specific survival (CSS) was 20 months and 5-year CSS 29.2%. In case of complete pathologic response to induction chemotherapy (N = 40; 26.8%), median CSS was 127 months and 5-year CSS 63.5% (P <.0001). Clinical and pathologic responses to chemotherapy were predictive parameters with respect to CSS and recurrence-free survival. Combined local and nodal responses resulted in a significantly better outcome, compared with isolated nodal or local response (P <.0001).

CONCLUSION: Prognosis for NPBC remains poor despite the use of induction chemotherapy. Nevertheless, in the present series, 1 of 4 patients showed complete pathologic response to induction chemotherapy with subsequently a significant CSS benefit (median CSS 127 months and 5-year CSS 63.5%). Clinical and pathologic responses to chemotherapy are predictive parameters for outcome.

Original languageEnglish
Pages (from-to)134-139
Number of pages6
JournalUrology
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 2014

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Combined Modality Therapy
  • Female
  • Humans
  • Induction Chemotherapy
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Treatment Outcome
  • Urinary Bladder Neoplasms
  • Journal Article

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